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Promising Intervention to Improve Asthma Management

Singapore General Hospital (SGH) and AstraZeneca unveil new model of care for asthma patients to improve care and outcome in the emergency department.

Non-compliance to medication or regular follow-up with doctors could result in asthma patients being rushed to the emergency department (ED) for severe symptoms like breathing difficulties, which can sometimes be life-threatening. At Singapore General Hospital (SGH), almost 50 percent of the asthma patients at ED show up at night or early hours in the morning.

To reduce ED visits and hospitalisations, SGH, in collaboration with AstraZeneca, piloted a new model of care known as Asthma-COPD Afterhours Respiratory Nurse at Emergency or A-CARE in 2018 to empower asthma patients how to better manage their condition.

Dr Kenneth Tan, Head and Senior Consultant, Department of Emergency Medicine at SGH said, “One in two asthma patients we see in the emergency department generally come in the evening. We treat them according to the severity of the attack, and admit them if their condition does not improve. If they feel better, we will discharge them with a referral to see their usual asthma care provider. But we realised the moment they leave the hospital, our opportunity to educate patients on better asthma control is gone. That explains why these patients keep coming back.”

Within this programme, a nurse specialized in asthma care worked three nights a week in the ED. The nurse taught patients the correct use of inhalers, provided brief asthma education as well as self-management plans for patients. The nurse then discussed with ED physicians to make joint patient care decisions, made recommendations for asthma inhaler therapy and appropriate post discharge follow-up.

The 17-month pilot showed that the joint care by the A-CARE nurse and ED physician has led to a number of findings. The likelihood of patients being prescribed with oral steroids (emergency treatment) improved from baseline of about 60 to 90 percent. The likelihood of patients being started on controller inhalers (long-term anti-inflammatory treatment) improved from baseline of 30 to 70 percent. The likelihood of patients being referred to respiratory specialist for follow up in SGH increased from 70 to 90 percent. In addition, patients who received counselling by A-CARE nurse were more likely to turn up for a follow up respiratory specialist appointment compared to those who did not, 40 percent compared to 15 percent.

Associate Professor Koh Siyue Mariko, Senior Consultant, Department of Respiratory and Critical Care Medicine at SGH, on the results and future plan, “We are very encouraged by the positive results of A-CARE, and will build on the success of the pilot model to introduce A-CARE 2.0 or TRAINED. TRAINED aims to train ED staff in asthma counselling so that all asthma patients being admitted to SGH ED will be reviewed by a trained asthma nurse, regardless of the day of week or time of admission. We hope that this will ensure sustainability of the best practices and further improve outcomes of asthma patients in Singapore.”

Vinod Narayanan, Country President at AstraZeneca Singapore, said “We are thrilled to see such promising findings from the initial A-CARE programme and are pleased that we are able to roll out the TRAINED programme soon to optimise the patient experience further. As a global, science-led biopharmaceutical business, we know that acute hospital admissions for severe-life threatening asthma attack is a global issue that many health systems have to deal with. This is why we invest in initiatives like A-CARE and TRAINED through our Healthy Lung Programme.”

The findings of the A-CARE model are published in the British Medical Journal Open Quality journal, a leading international peer-reviewed publication. The collaboration with SGH is also part of AstraZeneca’s Healthy Lung Programme, a programme designed to build local health systems to support the diagnosis and treatment of respiratory diseases. [APBN]